Yesterday saw one of the boldest moves in Queensland politics for quite some time; Premier Anna Bligh announced that Queensland Health would cease to exist as from July next year, to be replaced by two smaller agencies, one for corporate services and a A Hospitals and Health Care Agency which would co-ordinate the provision of health services through local networks.
This comes in the wake of the scandals that have continued to plague the massive bureaucracy, which employs 80 000 people, most recently the alleged theft of $16 million by an executive.
The Premier’s media release said:
Queensland Health as we know it is over.
Anyone who’s had dealings with QH will know this is undoubtedly a good thing. Risk-averse, top heavy and sclerotic might be three apt descriptors for QH’s corporate structure. It is unresponsive both to political leadership and to grassroots initiatives from staff and clinicians.
There is a process in place for making the transition, and I hope that process will be open to public and expert input, and to serious consideration of the implementation of decentralised patient centred models of care, whose necessity and desirability have been held back or unrecognised by the current Corporate Leviathan.
It should also be much easier to configure new structures to interact with Medicare Locals and the other aspects of the shifts in governance and financing that accompany the Gillard Government’s health reforms.
This is a decisive and hopefully transformational announcement, and I think bodes well for more policy creativity from the Bligh governmment as we head into the new year, and the election that is to come.
I’d like to understand why it was necessary to split the organisation into two. I heard her announcement on the radio and it came across to me as just wanting to be seen to be doing something, with no guarantee at all that they’ll be in a better position in the end. She said the culture at the organisation is poor, but splitting it into may merely result in two organisations with a poor culture with even worse communication between the two new organisations.
Why isn’t it possible to reform the current organisation in place?
Chris, because it’s so large and unwieldy. She’s right that there have been many attempts. The idea here is to shift power downwards and closer to service delivery, and to separate out corporate services from policy making.
Kim @ 2 – I guess what I have an issue with is the “large and unwieldy” bit being the fundamental cause of the problems. There’s obviously very very poor financial controls in Queensland health and splitting it into two organisations may reduce the amount people can steal at one time, but won’t stop theft unless they actually fix the financial control procedures.
All of which is possible within one organisation too if designed correctly. At the very high level someone is going to have to supervise and control the interaction between the two new organisations anyway. Without which over time there will be the inevitable divergence in procedures, IT systems etc which will lead to poor communication and inefficiencies betwen the two.
Chris, it’s not just the financial controls. Anyone, like I said in the post, who has had to have professional dealings with QH corporate office knows there are massive problems. A lot of it is being absolutely risk averse, and in fact in many instances, it’s the over-complexity of the control and governance systems that is precisely the problem (ie the payroll debacle). It desperately needs rethinking from scratch, and I think there is a lot in what Bligh says about wiping the slate clean in order to drive culture change. There are a lot of smart and talented people working in QH, but the organisation itself has become a monster.
I don’t dispute that there are lots of problems with QH. I’m just questioning what it is about splitting the organisation in two that can’t be done by retaining it as a single entity. You don’t need to do this to wipe the slate clean to drive culture change – you might need to change a bunch of managers who refuse to adapt – but you’ll need to do that anyway if you want things to change.
At the risk of repeating myself it seems like this is a political fix – Bligh will be able to say she did “something big” and point to how there are now two organisations, rather than having to justify that things are actually better.
In a decade or so politicians will be talking about how things would be so much better if they merged the two health related organisations because they don’t coordinate well
Chris – I don’t want to say too much about it publicly, because I did some work with QH, but this is the right thing to do and I have no doubts about the validity of the decision. Implementation, and getting the model right, is of course, key, and I share Kim’s hope that there will be a chance for input into how it is reshaped.
I am inclined to see this as a sign that Qld Labor have the fear… despite our only alternative being the as yet, unelected leader of the opposition.
As the partner of a QH employee, it seems from this distance that it is a department that is totally over bureaucratised, a lot of it driven by obsession with hierarchies of power within hospitals, has an aversion to any kind of imagined risk at all, and chooses to focus on number crunching and perceptions, rather than providing good health services to the public. I also think this is as much the fault of politicians as public servants.
The frontline staff, are on the whole fantastic and hard working.
I’d also point out that QH has been crying out for a political fix. It’s precisely bold and creative political intervention that’s needed.
I just hope it is bold and meaningful change Mark, the way it was announced seemed to hint at desperation and seemed a shrill ‘reaction’ to the embezzlement issue, rather than as a considered response to the fact that QH is failing people who need health care and those who deliver it.
I wonder if this would be a good idea with the NHS as well?
Try saying that anywhere in English politics and surviving to the end of the day …
The other way of looking at it, Verity, is that it’s been in contemplation for some time and the latest shenanigans provided a circuit breaker. There have been a lot of shakeups in QH Corporate over the last six months, and that may have been preparatory to this.
I do agree, as I said, it’s really important that this be implemented very carefully.
I can’t see there being a lot of input from anyone if KPMG are coming up with the plan in 6 weeks over the Christmas holidays. It beggars belief that the greatest change in health delivery in Qld can be even outlined in this time period.
I’d also like to point out that the payroll “debacle” was kindly provided by Corptech, which is already a corporate services provider external to Health.
Even if separating the delivery and support arms of Health is the right thing in the long run, the timing and implementation of this is nothing more than a cynical attempt to provide a standard answer for candidates at the election.
How long have QLD Labor been in power? Who created this mess?
Probably blame it on Jo, wilful.
Mark @ 6 – if they’ve been thinking about this and doing some planning for a while then that’d be great – and its not as reactionary as it sounds. I can’t see how they’d have a detailed implementation plan in 6 weeks over Christmas otherwise, since that would have to take into account feedback from the various groups internal and external to QH.
Mark, Kim,
I hope you are right, that it does go some way to fixing the problem. For all I see is another way for politicians to level endless criticism against the bureaucracy (who they built and encouraged through political risk avoidance) separate from attacking clinical staff which will earn them extra votes at the ballot box.
QH is every bit as you describe it, but I worry that the government is more than willing to throw hard working and dedicated IT, HR and Financial staff to the wolves as those who create the most issues and problems are protected and promoted.
I seriously hope this isn’t the type of reform that does that, but I have no confidence in any political class that thinks that this alone will solve it.
Hmmfph! The govt created the mess, stuffed Qld Health with clerical types. NOW, without any sense of irony, the premier decides the bureacracy is “too big”.
Gee, who made it that way?
Perhaps in the end, to achieve accountability & actual results, the govt will create local hospital boards.
The govt created the problem. By doing the very thing the premier now says IS the problem.
I know nothing about managing bureaucracies, but I wish Bligh luck. It seems in some respects that she is a brave woman surrounded by pygmies – all of whom are jumping ship now that things are not looking good for Qld Labor.
I love the way the people of Qld have turned on her now, after they clung to her during the floods.
Next step, abolish Queensland.
Next step, abolish Queensland
It really needs to be three states
1. Spiv Land, from Coolangatta to Noosa.
2. South Deliverance Land, south of the Tropic of Capricorn
3. North Deliverance Land, north of the Tropic of Capricorn.
Cue banjos …
“”I love the way the people of Qld have turned on her now, after they clung to her during the floods.”"
No, she was heaps on the nose before the floods, then she successfully clung to us.
On ALL levels, Qld has fallen behind the other states under Bligh and Beattie including Health, despite the mining booms( which the states get first dibs at constitutionally ).
Does anyone think QLD ALP can successfully do anything or make anything less complicated?
(Lucas payroll, Nuttall was Health minister ffs, Qld nurses still the lowest payedand higher workload)
I could say that the rot started under Goss (pokies anyone?) but that would only bring Rudd into it.
Chris @ 15: Like mark says, it’s been in the pipeline for a while.
Plans have been afoot within QH since at least sept 2010 that “A Health Services Support Agency (HSSA) will be established as a business unit within the Department of Health to deliver a range of services to LHHNs where service quality and efficiency can be better achieved by a state-wide network rather than locally controlled operations i.e. pathology, radiology and purchasing and logistics”. That’s framed as part of the state’s response to the National Health Reform program, aka the qld Health and Hospitals Network Act 2011.
You can’t blame Anna for a bit of the old ‘necessity as virtue’ shell game, using Joel as a rabbit of convenience to pull out of her millinary: that sort of Mr/Ms Fixit-in-a-crisis pyrotechnics works up here, ask Pete. There’s no electoral appetite for “we’re working slowly and solidly with the feds on this, have been for a while”, not these feds anyway.
While on the bill behind it all, legislation.qld.gov.au explanatory notes state “Networks will have the power to employ network chief executives and other health executives, but not other staff. The departmental chief executive will be the employer of other health service employees. However, it is intended that there will be a significant delegation of employment powers from the departmental chief executive to network chief executives where a network can demonstrate they have the appropriate capacity and capability to administer human resource matters.”
The QPSU newsletter of the time noted: “In an important last-minute move, the Government decided that Queensland Health workers will continue to be employed by the Director-General of Queensland Health after the networks are established rather than by the networks themselves. This is good news as having a single employer for all workers in Health will make it easier for union members to ensure our wages, entitlements and rights to fair treatment are persevered and honoured into the future”
Thus the legislation, as tabled, per that last-minute move, in Clause 20:
(3) A network may employ health executives
(4) However a network may not employ staff other than health executives
That’s it, end of clause, and brutally clear. No mention of the original (feds formula?) intention to eventually delegate HR powers to the locals, no siree, not on your life, not if the QPSU can help it, and clearly they can. If I might draw a parallel, it’s gonna be like state school principals not being able to hire and fire. We’ll have a health system as good at what it does as the education system, for the same reason. Ahem, Qld schools rate where?
Yep.. 6 weeks for a detailed implementation plan to split more than 80,000 staff. Over the holidays.
I’m prepared to bet it would take at least half that to get an accurate list of how many sites they have staff at and what those staff are doing. Health isn’t just hospitals, and doctors aren’t the only service providers. That political truism has been a major problem for a long time.
I’m inclined to think this will in practice be very difficult. Many staff perform both service delivery and administrative roles. It will simply not be possible to continue service delivery if staff are forced into administration, and vice versa. I’m surprised that a geographic, rather than a vertical/bureaucratic, split wasn’t considered as a preferable option. It has the hallmarks of a panicked move to try to manufacture an image of decisiveness, a la Beattie. I hope I’m wrong.
A geographic split doesn’t work for things like payroll, IT, facility management and centralised labs, HAL. That’s why the separation looks so attractive. At a whole of government level they already tried the IT and HR service provider model and it didn’t work.
Maybe KPMG can get it going over christmas.
I am slightly sceptical because I know that the whole “IT as a service provider to internal customers” style model that’s often seen as a benchmark in this area is just plain wrong. For a start, there’s no such thing as only an IT “system”, all information technology actually drives / is driven by the actual process it forms part of.
What happens when clinical practice requires innovation in the systems that deliver information to the fingertips of the practitioners? I mean things like patient records management and the link with clinical data. You’ve probably already got all these “process” roadblocks in getting such improvements but I am skeptical externalising the responsibility even further will make things any better.
The federal government’s grand scheme to improve these things won’t work either. Mainly through the implementation detail that the big consultancies (Accenture in this case, KPMG for Qld Health) impose. They are the very opposite of agile or responsive to needs. They work by squeezing margins out of contract management and Big Up Front Design and Requirements Lockdown.
Besides which, if the LNP win the next state election the fuckers will use this “support” agency as a way to drive privatisation. Mark my words – “it’s only external service provision” they’ll say. Then the low grade “IT industry” spivs that infest QLD govt contracts land will load everyone up with massive multi-millions middleware licensing deals and lawyer-approved 300 page “SLAs” that don’t mean shit and make positive change impossible.
TR@26
I’d just been thinking of the analogy with IT outsourcing, and with the same dire results, myself. Well said.
Yeah HAL, the “received wisdom” even in the way that IT is run as an internal departments inside big orgs is usually very, very dire. The concept of internal “service providers” is frankly bullshit, and that logic leads straight to the outsourcing department.
Even if this QLD health split is done in a good way (and I have no faith in those big consultancy firms) – lets say leaving clinical management systems with the frontline agency – I still think that the potential for either outright evil shitheads like the LNP or just straight-up clumsy management to make things even worse is a possibility that can’t be denied. But maybe QLD Health support services are run in such an incompetent way (and all the evidence suggests it might, I suppose) that almost any change is liable to improve things.
I suspect it will be decentralised geographically and functionally split. Ie the corporate services aspect will have local networks as customers, and the health agency will be a small policy and governance centre. There’s always a potential problem with this sort of model too, but there’s also the fact that you often can’t support the full host of necessary functions in smaller and more remote hospitals and health services.
I also share some concerns about KPMG, but I worked on a number of contract research projects for the Federal Government in which they also had a role, and they do have a depth of experience in health policy and health systems that isn’t present in some of the other large consultancy outfits.
I’d be surprised if KPMG didn’t write themselves a lucrative ongoing role in the restructure, Mark. More to the point, the LNP has already repudiated the decision. I imagine they’ll want to reestablish the old hospital board model that put their people into remunerated positions of local power. The likely chaos that will still reign at QH by election time will give them an excuse to do whatever they like.
Meanwhile, I’m interested in your take on what appeared to be a joint media event today where the LNP spokesperson (Nicholls I think) and Alex Scott from the Together union (formerly State Services Union) demanded minister Wilson resign or be sacked under ministerial accountability doctrine. Several public servants have been suspended pending various investigations, although they’re not even suspected of any involvement in the fraud.
Bligh quite reasonably pointed out that Wilson has only been in the job a short time, but the history of Nuttall’s and Lucas’s misrule makes the case against Wilson easy to prosecute. Public servants were sacked in the payroll scandal too. Beattie was fond of sacking public servants and staff whenever events made his regime look bad (remember Wine-gate?), but stuck by smelly duds like Nuttall – and the media will surely remind the electorate of this.
At any event, it looks like the public service union is cosying up to the LNP with Bligh’s management of this latest QH fiasco as the catalyst. The last time such a realignment of the spheres happened was in 1995, IIRC. And that did not turn out well.
While it’s probably a good thing that QH is gone (and good riddance), Bligh needs to be careful to avoid turning the Queensland Government into a patchwork of feuding bureaucratic fiefdoms. There is a *very* fine line to walk here, and I am pleased that Bligh has chosen to walk it – her incumbency in office has shown that she is capable enough to walk it if she puts the effort it.
Hal: that would be the same Alex Scott that “quits ALP to start lobby group” back in June, non?
He of the “We recognise in the current circumstances that the size of the public service particularly in non-frontline areas has to be reduced” while being onside with Campbell for the removal of a salary rise cap for those that remain?
Will Tognini’s become the new Brekky Creek ?
http://images.brisbanetimes.com.au/2011/12/14/2839060/newman_729-420×0.jpg
Where is the accountability for the complete lack of ministerial oversight and bumbling up to now? Bligh, through her actions, has decided to throw responsibility onto the system itself – though the decision might improve things. Ultimately it was her government, and decisions taken by it, that saw a multitude of payroll problems that hurt thousands of people. The latest fraud is just the straw that broke the camel’s back, and as far as I can tell, fairly unrelated to the structure of the department.
If this new change will go ahead, why is this departmental change limited to Queensland Health? Why not split all departments this way, and have genuine non-political and competent oversight of government spending, departmental governance and administration? Why not make this new department over arch all state departments?